Individual provider Active NPI

Cullen Durkin Farragher, DO

  • Student in an Organized Health Care Education/Training Program
  • Canton, MI
National Provider Identifier
1144911553
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
5151016073 Issued in MI
Practice address
1051 N Canton Center Rd
Canton, MI 48187-5097
Phone
(734) 539-5080
NPI assigned
May 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5151016073 MI Primary

Addresses

Primary practice location

1051 N Canton Center Rd
Canton, MI 48187-5097

Mailing address

1522 Simpson Dr MPB D3230
Ann Arbor, MI 48109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230626001752 MI Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 1557729456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5151016073MIMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1144911553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 SIMPSON DR MPB D3230",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875097",
            "telephone_number": "734-539-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRAGHER",
        "first_name": "CULLEN",
        "middle_name": "DURKIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-17",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5151016073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

Verify at the official NPI Registry.